Statewide Trauma System Cuts Preventable Deaths By Half

From 30% to 16% in four years

A study out of Arkansas supports the argument that a well-regulated statewide trauma system is a money-saving investment.

Charles Mabry, MD, an associate professor of surgery at the University of Arkansas for Medical Sciences in Little Rock, was on a team of analysts that compiled an economic impact analysis of the Arkansas Trauma System, which was launched in 2010 using $20 million from a special tax on cigarette sales.

Mabry says his analysis may be the first to evaluate the ROI on a statewide trauma network. Most states have regional networks, and before 2010, Arkansas's trauma network was scattershot, and had no state-designated trauma centers.

The launch of the statewide network in 2010 created a pronounced before-and-after line of demarcation that allowed for comparison.

The analysis, appearing this month in the Journal of the American College of Surgeons, found that over the past five years, the statewide trauma system has reduced preventable deaths by 48%, saved 79 lives in a 12-month period, and saved $186 million, providing taxpayers with a nine-fold return on investment.

The study compared statistics in 2009–the year before the statewide trauma system went on line–with a 12-month period between 2013 and 2014, when the system was up and running.

A Steep Drop in Preventable Deaths

In 2009, the preventable death rate was 30%. That rate dropped to 16% after implementation of the trauma network, a 48% decrease in preventable deaths. The difference equates to 79 lives over 12 months. (For details on the rather extensive methodology, see the report.)

Mabry's team calculated the value of a life using a standard estimate of $100,000 per life-year, with an average lifetime expectancy of 81.5 years, for a lifetime value of $2.36 million per person saved.

The value of a life considers that person's lost earning potential and other costs to society, such as the financial impact on members of a family that may need social services after the death of a breadwinner. Based on that methodology, Mabry called the savings "a conservative estimate," in part, because most trauma patients are relatively young.

The average age of trauma patients who die is 42. "Most of them have families," he said. "It is a bit of a guessing game, but the younger the patient the more valuable the life saved."

The statewide trauma system links every ambulance under one coordinated emergency medical services network. "The ambulances can describe the patient to the central dispatch area and, while the dispatch can't tell them where to go, they advise them where to go based on their knowledge of the patient and also where the resources are," Mabry said.

"Along with that, we have a statewide electronic, web-based dashboard and each hospital updates us on an hourly basis if it changes, about their capabilities and capacities," he said.

"At our hospital in Pine Bluff, if we have a major trauma and all of our surgeons are tied up, we will let them know. That way if something happens and a patient ordinarily would come to our center, the central dispatch would know to send us to another hospital."

Trauma Standards

Mabry said the hospitals determine if they want to apply to be a trauma center and the state health department conducts an inspection of a hospital to see if they meet certain standards.

"Those standards are generally based on the American College of Surgeons standards for trauma centers, although we did alter them a little bit for our states," Mabry said.

"For instance, for a Level II trauma center for the College of Surgeons standards you have to have a full time, on-call ophthalmologist, those types of things. In our state we found that wasn't necessary. Plus, we don't have ophthalmologists on staff in most hospitals. They're all outpatient, so we altered it a little bit."

In some states, Florida and Texas in particular, hospitals seek trauma center status to cash in on lucrative trauma activation fees associated with that status, sometimes to the detriment of patients.

Mabry said that isn't a problem in Arkansas.

"We don't have an oversupply of hospital in Arkansas," he said. "We have too many patients and not enough hospitals to begin with, so we don't have a problem with hospitals trying to compete with one another for trauma center status."

If other states are contemplating a statewide trauma network, Mabry said a critical component for success must be a dedicated funding source.

"We are very fortunate that our governors and legislatures have allowed us to have the funding. That $20 million is a lot of money around here, and that has driven a lot of the innovations in the trauma system," Mabry said.

"For instance, the trauma wristband is very helpful. Every time the ambulance picks up a patient, at the first point of contact they have a pre-numbered wristband applied to the patient and that number follows them all the way through the trauma system. If there are problems along the way, we can identify them."